Meaning-oriented programs for addiction are not unknown. Most are applications of Frankl’s logotherapy (Crumbaugh et al. 1980; Somov 2007). Singer (1997) developed a meaning-oriented therapy, based on McAdams’ (1993) narrative approach. Yalom (1974) described his existential group therapy with alcoholics, and Ballinger et al. (2008) presented an existential-integrative approach with an alcoholic.

This paper describes a positive existential therapy recently implemented at the Sunshine Coast Health Center (SCHC) in Powell River, British Columbia. SCHC is a private, licenced, for-profit, residential facility for addicted men.

The program is based largely on the theory and practice of Meaning-Centered Therapy (MCT), developed by psychologist Paul Wong (1998, 2008, 2009). Wong was heavily influenced by Frankl’s (1988) proposition that the fundamental motivation in humans is the will to meaning, the need of the individual to make sense of his or her life and pursue a personally meaningful existence.

MCT extends Frankl’s existential psychotherapy, integrating cognitive-behavioral, narrative, multicultural, and positive psychologies under the organizing construct of personal meaning. Recognizing that most mainstream treatment focused only on abstinence or reducing harm, Wong suggested that a meaning-centered approach could move beyond providing a measure of physical and mental stability:

Such a positive existential approach recognizes that the goal of addiction treatment is not only recovery from addiction, but full restoration to the fullness of life . . . . The recovery process needs to move beyond healing of brokenness to personal transformation and full integration into society. (Wong 2006, p. v)

Addiction as a Response to a Lack of Meaning

Although early psychologists, especially William James (1902/1999), described the positive subjective experience of intoxication, the rise of behaviorism and prohibitionist attitudes shifted the perspective from the insider’s to the outsider’s point of view (Tart 1990). Where James had written that drunkenness “stimulate[s] the mystical faculties of human nature” (James 1902/1999, p. 421), the new psychology interpreted it as a lack of healthy-mindedness. Today, mainstream conceptions of addiction reduce it to a disease (American Society of Addiction Medicine 2001), brain disease (National Institute on Drug Abuse 2010), brain disorder (Vaillant 1995), maladaptive learned behavior (Marlatt and Donovan 2005), response to family dysfunction (Copello and Orford 2002), and other deficits. Motivational (Miller and Rollnick 1991) and solution-focused (Berg and Miller 1992) therapies provide alternatives to deficit approaches, but even these neglect the introspection and depth psychology that informed James’ ideas. The mainstream solution to addiction is to encourage a healthy-mindedness in addicts. Treatment typically consists of an eclectic combination of medications, cognitive-behavioral coping skills, motivation strategies, and other therapies to support the client’s shift to a healthy lifestyle. But successful outcomes are generally reserved for short-term studies. It has not gone unnoticed that despite agreement that addiction is a chronic condition, we evaluate treatments as if it were an acute one (McLellan 2002). Vaillant has been among the most vocal on this point, arguing that all long-term studies of, for instance, cognitive-behavioral and psychodynamic therapies have shown they are ineffective (Vaillant 2006, July 23).

A meaning-centered approach is an attempt to improve the effectiveness of treatment by recognizing that substance use operates at the level of fundamental motivations, beyond escapism, maladaptive coping skill, or neural adaptation. The starting point is Frankl’s assertion that “alcoholism . . . [is] not understandable unless we recognize the existential vacuum underlying [it]” (Frankl 1984, p. 129). The existential vacuum arises when the individual’s attempts to live a personally meaningful life are persistently frustrated. Frankl’s emphasis on the unique individual’s perspective is essential. Looked at from the outside, many SCHC clients are successful. They have families, social circles, good jobs, and material possessions. But their subjective experience is boredom, anger, depression, and loneliness, the symptoms that Frankl said arose from the existential vacuum. Our clients describe a nagging feeling of emptiness, a hollowness in their lives. Their narratives depict a lack of purposeful living, lost souls wandering about directionless. The addict’s life, said Narcotics Anonymous, is “meaningless, monotonous and boring” (Narcotics Anonymous 1982, p. 80).

In addition to feelings of emptiness and boredom, another example of the existential vacuum is a feeling of not fitting in the world. Recovered addict Eric Clapton’s opening line in his autobiography is typical of our clients’ life stories: “Early in my childhood . . . I began to get the feeling that there was something different about me” (Clapton 2007, p. 4). The Nobel Prize winning addict-writer, Eugene O’Neill, recognized that his own suffering arose from a feeling of separateness, a disconnection from others and from a higher power, which could provide meaning in his life. In Long Day’s Journey into Night, O’Neill, as the 23-year-old character, Edmund, summarizes the nature of his suffering: “I will always be a stranger who never feels at home . . . who can never belong” (O’Neill and Bogard 1999, p. 812). There is an uneasiness in the addict, a self-consciousness. As another O’Neill character put it, “I learned early in life that living frightened me when I was sober” (O’Neill and Bogard 1999, p. 692).

When we ask addicts the meaning they ascribe to the positive experiences of intoxication, they confirm Frankl’s thesis. Gregoire concluded that alcoholics drank in a doomed attempt to find “transcendence and meaning” (Gregoire 1995, p. 339). Trujillo (2004) reported that users of crack cocaine experienced intoxication as the supreme state, though counterfeit, of the feeling of being (dasein). This feeling included transcending the mundane, being awed at the beauty of the world, and freeing the mind to reflect on self and others. One of Trujillo’s participants described its appeal this way:

It’s like the whole world, life is beautiful. I feel great. I have a lot of ideas. My mind just opens tremendously. My mind is like really fast and I can think better. I feel good. I feel life is wonderful. I can do anything. (Trujillo 2004, p. 171).

Using discourse analysis, Riley, Morey, and Griffin identified “social and communal togetherness” (Riley et al. 2008, p. 218) as a key meaning that young people gave to their experience of ketamine intoxication. Hunt and Evans conducted a phenomenological study of 276 young people, mainly 18–24 year olds, on the benefits of ecstasy intoxication at rave dances. They reported that participants saw ecstasy as “transforming the everyday [and] highlighting the extraordinary or transcendental nature of the experience” (Hunt and Evans 2008, p. 337). Sumnall et al. (2006) found six major components of drug use based on a survey of ecstasy users. Among these, perceptual alterations, entactogenesis, and prosocial effects were most prominent.

Bill Wilson, the driving force behind the creation of Alcoholics Anonymous, informed the assembled crowd at the Shrine Auditorium in Los Angeles in 1948 that “An alcoholic is a fellow who is ‘trying to get his religion out of a bottle,’ when what he really wants is unity within himself, unity with God . . .” (as cited in Dick B., 2005). For Wilson, Frankl, Wong, James, O’Neill, and others, addiction is best understood, not as an escape from life, but as an attempt to satisfy a yearning to feel whole and find community. As James described it, drunkenness “brings its votary from the chill periphery of things to the radiant core. It makes him for a moment one with truth” (James 1902/1999, p. 421).

But this experience, for the addict, is ephemeral and doomed, because the vacuum remains. Frankl (1980) was convinced that “filling up this [existential] vacuum may well be of primordial therapeutic value—nay, a prerequisite for therapeutic success, and in any event a decisive component in the rehabilitation of the chronic alcoholic” (p. x). MCT is designed to be this decisive component.

MCT Theory

With its roots in Frankl’s logotherapy—literally, therapy through meaning—MCT is best considered an existential approach. It should be remembered that what makes an approach existential is not the methodologies used but the lens through which a phenomenon is viewed. One of the foundational principles of existential-humanistic psychology is its openness to different ways of knowing. MCT integrates what we have learned from different epistemological approaches about personality. Indeed, meaning as a benefit to health and as an organizing construct has much empirical support, including meaning research (Wong in press), logotherapy (Batthyany and Guttman 2006; Batthyany and Levinson 2009), hardiness (Maddi 2002), spirituality (Hill and Pargament 2008), and the positive psychology of eudaimonic happiness (Ryan and Deci 2001).

But the construct of personal meaning requires us to understand the subjective experience of the addict. As such, it shares many of the assumptions of existential psychology.

Existential Principles of MCT

The whole human being is center stage. MCT does not treat an addict or an addiction. Therapists do not assume that by virtue of having an addiction that a client is in denial or narcissistic or has some vaguely defined addictive personality. Existential-humanistic psychology arose as a response to the perceived weaknesses of psychoanalysis and behaviorism. Rollo May had challenged psychologists: “Can we be sure . . . that we are seeing the patient as he really is, knowing him in his own reality; or are we seeing merely a projection of our own theories about him?” (Schneider and May 1995, p. 82). In existential-humanistic thought, the individual is not reducible to one or a few traits, states, behaviors, or conditions. Singer concluded that we cannot reduce the addict’s “struggle to the common denominator of a genetic defect or a physiological problem of control” (Singer 1997, p. 17); rather, we must “take in the full dimensions of their lives—to see them as whole individuals struggling to achieve a sense of identity [and community]” (Singer 1997, p. 17).

The individual is growth-oriented. Maslow’s (1954) theory of motivation laid the foundation for the principle that the individual has an inherent tendency toward self-actualization. Similarly, Rogers believed that “there is an inevitable directional course in people and all forms of life toward increased complexity, differentiation, evolution, completion, and wholeness” (Cain 2002, p. 6). Research has indicated that if the addicted person can overcome barriers to this growth process, then a transformational change and values may result (Miller and C’de Baca 2001; White 2004).

The individual is the author of his or her life. In Existential Psychotherapy, Yalom described existential responsibility as follows: “Responsibility means authorship. To be aware of responsibility is to be aware of creating one’s own self, destiny, life predicament, feelings, and, if such be the case, one’s own suffering” (Yalom 1980, p. 218). The freedom to choose is, thus, the natural companion of existential responsibility. True, advances in neurocognitive psychology have shown that most of our decisions are unconscious (Myers 2010), but we must ask, with Yalom, “Whose unconscious is it?” (Yalom 1980, p. 229). While Yalom’s emphasis on responsibility for suffering is, perhaps, too simplistic—is someone’s suffering due to a diagnosis of terminal cancer entirely his or her personal responsibility?—most of the clinical effort at SCHC is in helping clients take control of their lives, regardless of circumstances or personal and social limitations.

Almost all existentialists refuse to pathologize clients. May, for instance, stated, “Neurosis is not to be seen as a deviation from our particular theories of what a person should be. Is not neurosis, rather, precisely the method the individual uses to preserve his own center, his own existence?” (May 1983, p. 26). Pathologizing addictive behaviors tends to encourage therapists to see the client as defective and in need of repair, an attitude that reinforces the stigma of addiction (Luoma et al. 2007) and, from the existential view, disrupts the therapeutic alliance.

Further Principles of MCT

Meaning-centered theory distinguishes itself from other existential models on several levels. In line with Frankl, Wong stated that MCT was anchored to the following proposition: “Humans have two primary motivations: (a) to survive, and (b) to find the meaning and reason for survival” (Wong 2008, p. 72). MCT pays special attention to helping clients find a reason for recovery. For example, most relapse prevention strategies fail because they do not account for the innate urge for meaning. The typical recovery plan includes outpatient counseling to work through issues, self-help meetings, diet and exercise, and other healthy-minded activities. What is missing is a reason to do all these things. Mechanically following an aftercare plan generally ends in boredom, leading to relapse.

There are little meanings and big meanings. Frankl maintained that finding meaning in the present moment is more useful than attempting to answer questions, such as Why am I here or What is the meaning of my life? MCT tends to focus on the little meanings, helping clients gain awareness that they react to the meanings they ascribe to events and others, rather than to the things themselves. In practical matters, MCT promotes doing the next right thing and acting according to one’s values rather than out of fear. But the pursuit of little meanings should not blind us to the fact that we must have a long-term vision. Without such vision, short-term goals are directionless. Wong’s Meaning Management Theory (Wong 2008) extends Frankl’s ideas by proposing that all of us need to manage three processes: meaning-seeking (find meaning in situations), meaning-making (construct meaning through personal action), and meaning-reconstruction (transform a negative into a positive).

Meaning therapy is forward-looking. From his experience in Nazi concentration camps, Frankl concluded that those able to survive the camps were “oriented toward the future, toward a meaning to be fulfilled by them in the future” (Frankl 1985, p. 37). Helping clients learn ways to reduce suffering is not enough. They also need awareness that pursuing personal strivings are equally important.

MCT emphasizes the positive givens of existence. All of us confront the negative existential givens of death, inevitability of suffering, recognition that we are fundamentally separate from others, and so on. But human beings have the capacity to dig deep within themselves and find courage, resilience, and other qualities, which Frankl described as the defiant human spirit. Even in the worst possible circumstances, human beings are still free to choose the attitude they take toward the situation. Unlike Yalom, for example, who focuses solely on the negative givens and thus on the inherent limitations of people, meaning theory promotes the individual’s ability to transcend biological and environmental limitations. MCT emphasizes the capacities of clients to take control of their lives, develop hardiness, find the courage to overcome fears, turn failures into learning experiences, and so on.

A key difference between Wong’s meaning theory and other meaning-oriented theories is his argument that the first step in meaningful living is the acceptance of reality, no matter how bleak (Wong and McDonald 2001). The refusal to accept reality is, essentially, the attempt to make demands on life. Clients early in their recovery often make unspoken demands on life. “I will get recovery if and only if. . .” and then demand “My parents quit nagging me,” “I can still have a beer or two when I want,” “I don’t have to take any risks,” and so on. But the reality of recovery makes demands of addicts. MCT therapists help clients shift from the need to control life to listening to what life demands of them. To take ownership of their lives demands that they accept families are angry at them, that having a beer reflects a misunderstanding of addiction, that recovery involves learning to live comfortably in the ambiguities of life.

Example of a Meaning-Centered Interpretation of Addiction

The following example shows how a meaning-centered approach can add insight into the nature of addiction. I have written at length elsewhere about this dynamic (Thompson 2006), but a brief summary is presented here. Mainstream therapists, with their healthy-minded view of addiction, often dismiss the chaos of the addict’s lifestyle as a symptom of drug use. But if we recognize the existential vacuum that underlies addiction, then it becomes clear that addiction has two complementary components: the drug and the drug lifestyle.

Vancouver’s notorious, drug-infested Downtown Eastside, the poorest postal code in Canada, has been a concern for politicians, police, and community groups. The mainstream generally tends to interpret the neighborhood as an example of the marginalization of addicts. Local television and newspapers call for taxpayer-supported housing and services to alleviate the suffering. But when we listen to those who live in the Downtown Eastside, we gain another perspective. One non-addicted resident once put a sign in his window, which read, “This is better than television!” The Downtown Eastside is filled with intensity, action 24 h a day. Visitors to Vancouver are often eager to visit the area because its notoriety has been promoted in the American and Canadian commercial film industry. The dark side of life has an appeal that middle-class society lacks.

From the mainstream view, the addict is ostracized, forced to live at the margins of society. But what the mainstream fails to recognize is that it is at the fringes of society where life is most intense. And addicts love intensity. “We made mountains out of molehills,” said Narcotics Anonymous (Narcotics Anonymous 1982, p. 93). The addict’s life is filled with emotional intensity, and addicts do not seem to care whether the emotion is anger, love, hate, happiness, or sadness. As long as emotion is raised to the level of a soap opera, it is good. Yet for all the time, effort, and money spent in getting and using drugs, nothing is accomplished, other than lost health, relationships, jobs, and friends. There is no goal, no purpose to addiction; it serves only to perpetuate itself. To put it another way: The addict lives intensely as a substitute for living meaningfully.

When therapists recognize that the intense lifestyle is actually a response to an existential vacuum, then it has great therapeutic value. Indeed, the lure of intensity must be addressed to provide clients with the best chance of recovery.

MCT Therapy

Rogerian Environment

One of the most important (perhaps the most important) aspects of SCHC’s program is that it provides an environment where clients feel free to be themselves. Carl Rogers (Raskin and Rogers 2000) was convinced that people would naturally actualize their potentialities if they were provided with the conditions of empathy, unconditional positive regard, and therapist’s congruence. Empathy requires the therapist to appreciate the world as the client interprets it, an active immersion into the client’s internal frame of reference. Unconditional positive regard invites clients to feel validated regardless of their feelings or state. This validation invites “the client to be whatever immediate feeling is going on—confusion, resentment, fear, anger…” (Raskin and Rogers 2000, p. 148). The client must also experience an authentic relationship with the therapist, which demands the therapist be genuine with clients.

Like all existential-humanistic approaches, meaning therapy is not technique driven. It relies on, what Bugental called, “ways of being” (Bugental 1976, p. xiv) with clients. Different therapists have different ways of being with clients. For Bugental, this was his concept of presence, a deeply attentive connection with the client, in which the client becomes aware of his or her being in the here-and-now. For Yalom, this way of being was rooted mainly within interpersonal relationships. For Rogers, it was a deep empathic awareness, which resulted in his understanding a client at a deep psychological level, well beyond what the client’s words conveyed. Similarly, MCT proposes that an authentic encounter between therapist and client is more important than any school or technique of psychotherapy. Therapy is as much about process as content.

SCHC’s environment is designed to counter the addict’s struggle with community. MCT recognizes that we are relational beings, with basic needs for belonging and attachment (Wong 2009). A Rogerian environment invites community, providing clients with an authentic experience of what it means to connect deeply with others, including staff members.

Acceptance that the Individual Client is the Author of His Life

Most residential centers have vigorously resisted providing a Rogerian environment. Much of this resistance likely has to do with the demands that a Rogerian approach puts on therapists:

Their faith in the client’s potential results in humanistic therapists’ disinclination to be directive but rather to act in ways that free clients to find their own directions, solve their own problems, and evolve in ways that are congruent to them. (Cain 2002, p. 6)

Because of the prevalence of deficit approaches, few addiction therapists appear able to muster this sort of faith in their clients. The Matrix Model, developed for those addicted to stimulants, for instance, is heavily behavioristic, under the argument that drugs have compromised the prefrontal cortex (Rawson et al. 2005). CBT coping skills training leaves little room for clients’ perspectives (Longabaugh and Morgenstern 1999), and even motivational therapies, which work with the client where the client is at, are directive (Miller et al. 1995). Rogerian principles require therapists to shake off these influences and assume their clients are the best experts on themselves and, given the right conditions, will realize their potential.

Family Program

SCHC’s family program is a meaning-centered approach for family members. Families do not tell their loved ones how much they have been hurt, under the assumption that their loved ones are in denial. The construct of codependence has no part in our program because of its deficit approach and lack of scientific validity. Rather, the program helps families appreciate they have developed certain coping skills to deal with the abnormal situation and that these coping skills may not be helpful. At a deeper psychological perspective, family members routinely tell us that they have spent so much time and worry on their loved ones that they have lost a sense of themselves. Just as we remind clients that they are the authors of their lives, we also remind families that it is their existential responsibility to make decisions that will influence their lives. Ultimately, we ask family members to consider whether they want to be the expert managers of another adult human being or whether they want to pursue their own dreams and goals.

Psychoeducation

Psychoeducation sessions provide a framework and a language for clients to come to terms with personal meaning. Frankl’s eulogy exercise helps them begin the process of discovering what is meaningful to them. We also present clients with research and allow them to make their own conclusions. A typical example is Bruce Alexander’s Rat Park studies (Alexander et al. 1981), in which rats showed no interest in morphine if they were free to be themselves.

Existential Coping Skills

Clinically, MCT helps manage their lives more effectively. Barriers to an authentic life are addressed, such as immediate concerns (for example, drug cravings), environmental influences (for example, dealing with drug-using friends), and personal issues (anger, depression, and anxiety). Therapy provides avoidance strategies, such as self-regulation techniques for decreasing anger or anxiety. But defensive coping skills are not enough. Therapy must also provide existential coping skills (Wong et al. 2006). Gaining awareness of who we are, how we fit in the world, our strengths and limitations, and the promotion of acceptance, humility, compassion, and forgiveness provide clients with the best protection against tough times and the best chance of pursuing life goals. Wong quoted O’Neil and O’Neil (1967) with approval:

By managing ourselves we come to know more completely what we want for ourselves, we come to know our priorities, our needs, our wants far more clearly; and this knowledge inevitably brings a greater sense not only of freedom but of security. The person who knows himself or herself, and manages his or her own life, can tolerate a higher level of ambiguity than before, can deal more successfully with anxiety and conflict because he is sure of his own capabilities. (as cited in Wong 2008, p. 243)

If Frankl is correct, that addiction is a response to an existential vacuum, then we must do more than simply focus on cognitive-behavioral coping skills, motivational techniques, and pharmacological interventions. MCT agrees with White (2004), who concluded from a study of sober alcoholics that abstinence may be a byproduct of meaningful living, not its prerequisite.

Narrative

Narrative is another vehicle that therapists use to help clients work through the existential vacuum. Wong argued that narrative is fundamental to MCT:

In its simplest terms, the meaning-centered approach emphasizes the human capacity for narrative construction and the healing and transforming power of meaning. It incorporates cognitive behavior theory and narrative psychology as import devices for transforming negative events and thoughts into coherent, positive stories. (Dobson and Wong 2008, p. 179)

The primary therapeutic exercise at SCHC is based on McAdams’ (1993) life story work. By deconstructing the client’s narrative in group therapy, the client discovers how he has answered the questions, Who am I and How do I fit in the world around me? These are questions of agency and community, essential components of MCT. Reconstructing the client’s narrative is the process of helping him find new ways of making sense of life, one more responsive to his authentic values.

Action

Yalom stressed that “In order to change, one must first assume responsibility: one must commit oneself to action” (p. 287). Frankl, borrowing some lines from Goethe, had stressed action over thought: “How can we learn to know ourselves? Never by reflection, but by action” (as cited in Frankl 1986, p. 56). Although MCT recognizes that many people hide behind action, it promotes constructive action as one of the most potent methods to discover what is meaningful for a client. Daily life at SCHC, such as meal times and recreational activities, is one of the best tools clients have for putting new skills into action.

The Therapist is the Therapy

A key principle of MCT is that the therapist is the therapy. Meaning therapy puts demands on the therapist. For instance, meaning therapy demands that therapists be self-aware. Yalom observed that although many therapists promote existential responsibility, “secretly, in their own hearts and in their own belief systems, [they] are environmental determinists” (1980, p. 268). At SCHC, we often hear therapists lament, for instance, that a client’s parents are to blame for his stuckness because they rescue him. Similarly, therapists fall into the tendency of believing that a client’s negative behavior makes the center “unsafe” for other clients, rather than believe each adult is free to make choices. MCT promotes the therapist’s self-awareness and vigilance in not falling prey to the client’s (and their own) willingness to give up responsibility.

Case Study

The first thing that Harry tells me when we meet is that his mother suffered from schizophrenia, and he is afraid that he “may have inherited some of her genes.” In less than 1 min, he has let me know that he is different than other people and that his problem is essentially some imposed factor (his genes), over which he has no control. Harry uses this to explain why he has suffered from anxiety since childhood. He has many more complaints. He’s 40, single, and lives alone because intimate relationships never seem to work out. He’s held onto a department store job since he left high school. During 22 years at a job he “hates,” he has been promoted to a middle-management position and recently fired for drinking at work. As I come to know Harry, I have the impression that, at some level of consciousness, he deliberately forced his boss to fire him by showing up drunk. Harry is more comfortable when others make decisions about his life. He’s here only because of a family intervention.

A mainstream therapist might diagnose Generalized Anxiety Disorder and Alcohol Dependence Disorder. Treatment would likely consist of easing Harry’s anxiety with medication and coping skills. Likely, a mainstream therapist would interpret Harry’s addiction as a form of self-medication. Indeed, asked why he drinks, Harry tells me it is the only thing that relieves his chronic anxiety. Also evident are adult relationship complications likely stemming from poor mother-child attachment (Schore 2005).

SCHC’s psychiatrist provides the official DSM-IV diagnosis and treats Harry’s anxiety. Connecting with others is a challenge for him, but, given time limitations, his therapy will revolve around helping him take control of his life.

The first step is to deconstruct Harry’s narrative. Deconstructing means listening to how Harry makes sense of himself and his place in the world. Two salient themes emerge: Problematic relationships and the job. He’s had two intimate relationships, each of which fell into his lap without effort on his part. Both were long-term relationships; Harry wasn’t satisfied with them but didn’t do anything about it. The first was 12 years, the second, 2 years. The first woman was a drinking companion, and she offered the consolation of being with another alcoholic. The second woman had recently ended a long-term marriage. Harry reported that its main benefit was “great sex,” not emotional connection. She introduced him to an educated, upscale crowd. Harry became quite animated as he described taking part in social gatherings of lawyers, engineers, and professors, where he was invited to engage in “intellectual conversations,” the only venue he experienced for this. But the lifestyle was unearned. When she ended the relationship, she ended the social gatherings, and Harry was left alone once more.

The relationship problems reflect his greater struggles to connect with others at an authentic level. In group, he is superficial. The other group members, having tried to engage Harry without success, pay little attention to him. During our initial individual sessions, he brings his ever-present notebook, in which he’s itemized things to tell me. He says he wants to make sure that I really understand him. But such behavior tells me that he’s too busy organizing himself to pay attention to the human encounter happening between us in the session, in the here-and-now.

I’m curious to know why he stayed at a job that he hated. He initially blames external factors, such as the weak job market and difficulty of retraining. Harry prefers to play it safe in life. But it’s important for Harry to understand how he exists in his world devoid of meaningful work and relationships. The answer: distracting himself by drinking and living vicariously in his imagination. Harry likes to search for opportunities to ramble on about cosmology, which he learned from PBS television shows. He becomes animated and more alert. This is, of course, his attempt at connecting with me, but it is also one way he distracts himself from looking at his life. When I point out his avoidance behavior, he is resentful at first. We spend time processing his methods of distraction, this thinking about things that have little relevance to the emotional pain that brought him to treatment. He tries to convince me that he does think deeply about his life and shows me his notebook filled with pros and cons of going to university to get a new career. He had researched and thought about it. Harry thinks all the time. At some level of awareness, Harry knows that despite all this planning, he’s too scared to act.

He’s afraid he’s not smart enough for university. While he tells me he believes he has good esteem, his behavior betrays him. One of the clinical benefits of a residential center is to watch clients outside of the therapeutic hour. Harry engages with other clients only at a superficial level of (pseudo-) intellectual debate. He rarely asserts himself in discussions over, for instance, which television show to watch or what to do on the daily outing. He routinely holds the dining room door open for other clients and is thus the last in the line-up. Daily behavior at a residential facility is a goldmine for therapy.

Our deconstruction of his narrative and behaviors has helped Harry accept that his life is one of loneliness, low self-worth, fear of taking action, allowing others to dictate his life. His is not a purpose-driven life. His past has few nurturing memories. His future exists only in his imagination, with no hope of action. He’s condemned to live in the present. Frankl had said that that for those who live only in the present, “Life consequently loses all content and meaning” (Frankl 1986, p. 100). As May pointed out, if the individual “is not growing toward something, he does not merely stagnate; the pent-up potentialities turn into morbidity and despair” (May 1953, p. 22). It is, perhaps, no surprise why Harry turned to the bottle. His life is meaningless, monotonous, and boring.

The events that brought him into treatment—lost relationship, being fired, family intervention—tell us both that his old narrative has run its course. Harry needs a new narrative, one that is more responsive to what is important to him: A new job that excites him, an intimate relationship. Although we cannot deal directly with the relationship, we can help Harry learn to connect with other clients at the center. I ask him to sit with different clients at meals and ask about what is happening for them. Another homework assignment is to ask each client for feedback on what they see in Harry. I reflect Harry’s behavior back to him during sessions. He begins to discover that how he treats others has much to do with how others treat him, which, in turn, influences how he sees himself—one of Yalom’s big points.

The content of therapy is to focus on employment. Harry knows that this means returning to school, but he’s afraid to act. We spend a great deal of time processing this, but not as an end in itself. Everything is directed at helping Harry shift from living in his imagination to starting to take charge of his life by going to school. I help him develop a plan and support him with the first step, a phone call to the university. But it will be up to Harry after he is discharged to follow through.

Conclusion

When SCHC shifted from a behaviorist model to meaning therapy, several benefits were apparent. Attrition dropped dramatically; in fact, many clients extended their programs. Alumni from the old program, who returned for a visit, remarked on the new positive environment. Treating clients as responsible adults eliminated most behavioral problems. Preliminary studies—client self-report surveys, client evaluations, exit interviews, follow-up surveys—have been promising.

Most clients in early recovery believe that they can stay away from drugs by avoiding what they do not want from life, such as the guilt that accompanies not being there for children, the frustration of family members, the painful liver, the empty bank account. But such defensive coping has only short-term benefits. Frankl reminded us that addiction was a response to an existential vacuum. What the addict needed for recovery was to live a personally meaningful life.